Age-Adjusted D-dimer for Venous Thromboembolism (VTE)

• The goals of the age-adjusted D-dimer are to increase the specificity of the test in patients ≥50 years old and prevent unnecessary testing and complications.
• Use of the age-adjusted D-dimer is not appropriate for patients who are high-risk based on clinical gestalt or clinical prediction scores, such as the Wells’ Criteria for PE (scores >4) or Revised Geneva Score (scores >11).

A patient with a D-dimer above the age-adjusted cutoff should undergo confirmatory testing with imaging (i.e., CTA, V/Q scan).

• No decision rule should trump clinical gestalt; high clinical suspicion for PE should warrant imaging regardless of risk score.

• Never delay resuscitative efforts for diagnostic testing, especially in the unstable patient.

• History and exam should always be performed prior to diagnostic testing.